Extended donor criteria in heart transplantation: a retrospective study from a single Chinese institution

Heart donor selection criteria have been progressively widened due to increasing donor recipient mismatch. This study evaluates the outcomes of the use marginal donor hearts for orthotopic heart transplantation (OHT) based on a single center experience in China.

We retrospectively analyzed outcomes of patients undergoing OHT in our hospital between September 2008 and December 2015. All the donor hearts were from voluntary donation of brain-dead patients. The primary outcome was overall survival; secondary outcomes included cardiopulmonary bypass (CPB) time, ventilation time, post-operative mechanical support and medium-term complications.

Overall, 278 patients with OHT were analyzed. Whereas 180 patients (64.7%) underwent OHT utilizing marginal donors (MD group), only 98 patients (35.3%) underwent OHT with standard donors (SD group). Compared to the SD group, the MD group had longer CPB time (P=0.001), ventilation time (P=0.010) and increased mechanical support rate (P=0.011). Survival rates were comparable between the two groups at 30 days, 1 year, 3 years and 5 years (92.2%, 83.3%, 70.6%, 70.6% vs. 95.9%, 91.4%, 80.2%, 80.2% respectively). Multivariate Cox regression analysis revealed that female recipient gender [hazard ratio (HR) =2.632 (1.325-5.227), P=0.006], diagnosis (P=0.014) and abnormal donor heart structure [HR =3.638 (1.005-13.167), P=0.049] were three predictors for 1-year all-cause mortality. The occurrence of complications in the recipients with more than 3-year follow-up did not differ between the two cohorts.

Marginal donor can be reasonably applied to expand the benefits of transplantation. Changing previous MD criteria to include donors with an age greater than 50 years, cold ischemic time less than 6 hours, donor/recipient weight ratio less than 0.8, compatible blood type, hepatitis virus seropositivity and MD used for male recipient will likely offer a good prognosis.